Question
How long do you have your pt’s with RA stay off of Humira and MTX after Athroscopic surgery of the shoulder, such as; a rotator cuff repair along with subacromial decompression and distal clavical excision. I am curious what you recommend because my Rheumatologist and Ortho have different recommendations.
Answer
There is no clear answers from the clinical studies. Thus, this is more my opinion rather than information supported by research. The concern is the risk of infection from surgery versus the risk of a significant arthritis flare if Humira is held. In general, I ask my patients to skip the dose prior to surgery (no Humira at least 2 weeks prior to surgery) and then do not restart Humira until 2 weeks after surgery. Hopefully, this gets you past the pneumonias and wound infections that are the most common post-surgical infections.
